Fact Check: Has India Undercounted Its COVID-19 Death Toll?

New Delhi: There have been some reports in the media, based on findings from recent studies in the US and European countries, that India’s toll of excess deaths during the pandemic could be in millions. The reports say that the official COVID-19 death toll is ‘vastly undercounted’.

Refuting these reports, the Indian government has said that US and European countries’ age-specific infection fatality rates have been used to calculate excess deaths in India based on the seropositivity.

“The extrapolation of deaths has been done on an audacious assumption that the likelihood of any given infected person dying is the same across countries, dismissing the interplay between various direct & indirect factors such as race, ethnicity, genomic constitution of a population, previous exposure levels to other diseases and the associated immunity developed in that population,” said an official statement.

“Given the robust and statute-based death registration system in India, while some cases could go undetected as per the principles of infectious disease and its management, missing out on the deaths is unlikely. This could also be seen in the case fatality rate, which, as of 31st December 2020, stood at 1.45% and even after an unexpected surge observed in the second wave in April-May 2021, the case fatality rate today stands at 1.34%.”

The government said that the guidelines laid down by the Indian Council of Medical Research (ICMR) are being followed and that the Union health ministry has always advised states to conduct death audits in their hospitals to report any cases of death that may have been missed.

Here is how the government has busted the myth

• The seroprevalence studies have another potential concern that the antibody titers may diminish over time, leading to underestimation of true prevalence and the corresponding overestimation of infection fatality rate.
• The reports assume that all the excess mortality figures are COVID deaths. Excess mortality is a term used to describe an all-cause mortality figure and attributing these deaths to COVID-19 is completely misleading.
• India has a thorough contact tracing strategy. All the primary contacts, whether symptomatic or asymptomatic are tested for COVID-19. The true detected cases are the ones that test positive with RT PCR, which is the gold standard of the COVID-19 test.
• There are more than 2700 testing laboratories in the country. Anyone who wants to get tested is able to get the test done. This coupled with vast IEC about the symptoms and access to medical care has ensured people could reach out to hospitals in case of need.
• The reporting of daily new cases and deaths in India follows a bottom-up approach, where districts report the number of cases & deaths to the State Governments and to the Union Ministry on a continuous basis.
• In May 2020, the Indian Council of Medical Research (ICMR) issued ‘Guidance for an appropriate recording of COVID-19 related deaths in India’ for correct recording of all deaths by States/UTs as per ICD-10 codes recommended by WHO for mortality coding.
• In addition to this reporting, the robustness of statute based Civil Registration System (CRS) ensures all the births and deaths in the country get registered. The CRS follows a process of data collection, cleaning, collating, and publishing the numbers, which although is a long time-consuming process, but ensures no deaths are missed out. For the expanse and the amplitude of the activity, the numbers are usually published the next year.